Acne Care

Acne, a common skin condition that arises when hair follicles become clogged with oil and inactive skin cells, is most common in teenagers but can occur in people of all ages. Even if it arises in adolescence, acne may persist into adulthood. Issues can involve whiteheads (closed and clogged pores), blackheads (open clogged pores), small red bumps, large painful lumps, cysts and other issues. Acne typically appears on the face, neck, back, and chest.

Scientific research has shown that acne can significantly impact mental health, leading to issues like lowered self-esteem, social withdrawal, anxiety, and depression. Compounding these challenges is the fact that many people become frustrated with unsuccessful attempts to clear their skin. This is often due to overwhelming and confusing information on social media, which leads to ineffective self-treatment using over-the-counter medications. While there is no “silver bullet,” there are many proven strategies that can help you manage and reduce acne breakouts.

A successful plan involves customizing your treatment to your skin and acne type. Achieving acne care results often necessitates a combination of different approaches and the adjustment of ineffective treatments until a positive response is observed. This can involve the use of topical solutions or oral medications. A physician might also recommend procedures like laser therapy or chemical peels that target and alleviate the causes of acne, such as excess oil production, bacteria, and inflammation.

Acne can be stubborn, and frustration is common. The treatment of acne can be tedious and often difficult until a solution is found. But effective acne treatment, once identified, can help individuals regain smoother, clearer skin, leading to an enhanced sense of well-being and confidence in their appearance.

Seeking professional help from a dermatologist is critical for improving acne issues and preventing long-term scarring, which can be an even more challenging problem to correct.

Acne typically progresses through two main phases: the active phase, marked by breakouts, and the healing phase, which can leave behind acne scars. Active acne refers to the presence of inflamed, red pimples or pustules on the skin caused by clogged pores and bacteria. Acne scars are the residual marks or indentations left on the skin after the active acne lesions have healed.

Acne treatments do not improve your skin overnight. Active acne is primarily treated with topical medications, antibiotics, or oral medications that target the underlying causes, such as excess oil production and bacteria. Chemical peels and lasers are also great tools if traditional treatments prove ineffective in dealing with active acne.

Acne scars are primarily addressed with laser therapy, microdermabrasion, or chemical peels, focusing on skin resurfacing and collagen stimulation that reduces scarring.

Let’s take a look at common topical treatments used for active acne.

• Benzoyl peroxide is an antibacterial agent that reduces acne-causing bacteria and also helps to unclog pores. It’s available in various strengths and in the form of creams, gels, or washes. It reduces inflammation, kills bacteria, and prevents new breakouts.  Benzoyl peroxide is the most common ingredient in over-the-counter acne treatments and often the first product people use when they start developing acne.
• Retinoids are molecules derived from vitamin A. They regulate skin cell turnover, prevent clogged pores, reduce inflammation and can reduce acne scarring. They are available in prescription-strength or over-the-counter formulations.
• Salicylic acid is an over-the-counter ingredient that exfoliates the skin, unclogs pores and reduces inflammation. It is commonly found in cleansers, toners, or spot treatments. It helps prevent pore blockages, reduces acne lesions, and improves skin texture.
• Topical antibiotics reduce bacteria on the skin’s surface and inside pores to decrease inflammation and infection. They can help to clear existing breakouts. Overuse can lead to antibiotic resistance. It is typically recommended to use them in combination with other acne treatments.
• Anti-inflammatory topicals like Aczone® (dapsone gel) work by reducing inflammation and bacterial growth associated with acne, diminishing the severity and occurrence of breakouts. Aczone® is available in prescription concentrations and should be tailored to the severity of the acne and the patient’s skin type.
• Antiandrogen topicals like Winlevi® (clascoterone cream) work by targeting androgen receptors in the skin, reducing the production of oils that can lead to acne formation. Winlevi treats acne by directly addressing hormonal factors that contribute to acne development, making it effective for those with acne related to hormonal imbalances.

Common oral treatments include the following:

• Isotretinoin (Accutane®) is a potent retinoid that targets severe acne by reducing oil production, skin cell turnover, and inflammation. It is typically prescribed for persistent acne that hasn’t responded to other treatments or for those with heavy scarring.

Accutane®can dramatically reduce acne lesions, prevent scarring, and often provide long-term remission. It requires careful monitoring due to potential side effects such as dryness, increased sensitivity to sunlight, and more severe, though rare, side effects. Pregnant women should not use isotretinoin due to the risk of severe birth defects. It is crucial for women of childbearing age to use effective contraception and undergo regular pregnancy testing before, during, and after treatment with isotretinoin to prevent exposure during pregnancy.

• Oral antibiotics like doxycycline reduce acne by fighting bacteria and reducing inflammation. They are often prescribed for moderate to severe acne or as a short-term treatment. They can reduce inflammation, eliminate acne-causing bacteria, and help clear up existing breakouts. It’s worth noting that prolonged use can lead to antibiotic resistance and may cause side effects like upset stomach or increased sun sensitivity.
• Spironolactone was originally approved as a diuretic but is used off-label for hormonal acne or acne that is resistant to other treatments. It reduces oil and sebum production and can be especially effective for adult females by reducing androgen levels. It might cause side effects like increased urination, breast tenderness, or irregular menstrual cycles.

Spironolactone is not recommended for pregnant women. Before prescribing spironolactone, doctors perform a pregnancy test and blood tests to check electrolyte levels, kidney function, and liver function. During treatment, regular monitoring through pregnancy tests and blood tests is necessary to ensure safety and prevent potential complications.

There are also several in-office treatments for acne that a dermatologist may recommend to help with current and future outbreaks, especially if it proves unresponsive to topical and oral medications. Each treatment has its unique benefits and considerations.

• Comedone extraction is the manual removal of blackheads and whiteheads using sterile instruments. It can clear blocked pores and prevent acne lesions from worsening. There is an immediate reduction in pore blockages and an improvement in skin texture. It should be done by a skin care professional to avoid scarring and infection.
• Intralesional steroid injection involves injecting a diluted steroid solution directly into inflamed cysts or nodules. It quickly reduces inflammation and swelling and speeds up the healing of severe acne lesions. This treatment should be done only in select cases by a dermatologist who has expertise in acne treatment, as potential side effects include skin atrophy, discoloration, or a divot at the injection site.
• Chemical peels remove the top layer of skin, unclogging pores and reducing oil and bacterial buildup. They remove dead skin cells and stimulate skin regeneration. Additional benefits include reduced acne lesions, even skin tone, and improved skin texture. There are varying depths of peels available. Some may cause temporary redness or irritation. Note that chemical peels pose increased risks of hyperpigmentation and scarring for people of color.
• Microneedling is a minimally invasive procedure that involves using fine needles to create tiny punctures in the skin, stimulating collagen production and promoting skin regeneration. This treatment can be an effective part of acne treatment by reducing the appearance of acne scars and improving overall skin texture.

Additionally, microneedling can enhance the absorption of topical treatments, making them more effective in managing active acne. Microneedling combined with radiofrequency (Morpheus8™, Profound® RF, Sylfirm X™) is another effective approach for treating acne scars, as the added heat energy further stimulates collagen and elastin production, resulting in smoother, firmer skin.

• Laser therapy and light therapy involve utilizing various energy-based devices to target acne bacteria, reduce inflammation, or shrink oil glands while promoting skin healing. The results include improved acne lesions, reduced redness, and stimulated collagen production. Multiple sessions may be needed, and side effects can include temporary redness or sensitivity. Sun protection is critical to avoid complications. For people of color, laser treatments carry a higher risk of side effects, such as hyperpigmentation or scarring, due to the greater melanin content in their skin.

The most effective energy-based devices for acne treatment include blue and red light therapy, pulsed-dye lasers, and radiofrequency systems. AviClear® is an FDA-cleared device for the treatment of mild, moderate, and severe acne. It uses laser light to selectively target and eliminate acne at the source without the need for prescription medications. Multiple sessions are typically recommended.

• Acne scar management in adults often incorporates a blend of techniques, tailored to the scar type and severity. Laser therapy is frequently used to resurface the skin, diminishing scar visibility, while chemical peels or microdermabrasion remove the upper skin layer, encouraging the growth of smoother skin.

For indented scars, injectable fillers or fat grafting can elevate the scar area. There are also minor surgical options like subcision, which involves breaking up fibrous tissue beneath the scar. In some cases, individuals benefit from a more comprehensive surgical procedure, such as a facelift, which can release adherent scar tissue, tighten the skin, and significantly reduce the appearance of scars.

All of these treatments have their own risks and benefits. Be sure to discuss your goals and concerns at length in consultation with your dermatologist or plastic surgeon.

Before you go

The consultation with your dermatologist or plastic surgeon for persistent acne or acne scars involves an in-depth evaluation of your skin and medical history. To prepare, you should bring a list of all previous treatments, current skincare products, and any relevant medical information.

Be sure to ask about the benefits and risks of recommended treatments, and expected outcomes. Based on the assessment, your specialist will recommend a customized treatment plan, which may include topical treatments, prescription medications, medical procedures such as chemical peels or laser therapy, or other advanced therapies tailored to your needs.

If your physician plans to perform a deep chemical peel or more invasive laser treatments, they will prepare your skin with a regimented skincare plan several weeks in advance. Additionally, they will recommend avoiding sun exposure for several weeks before and after the treatment to prevent complications such as post-inflammatory hyperpigmentation. Proper preparation and sun avoidance are crucial for optimal results and minimizing the risk of adverse effects.

The ultimate goal is to effectively treat active acne and prevent or minimize scarring for clearer, healthier skin.

During the procedure

In-office treatments for active acne often include procedures like light chemical peels and laser therapy, which help reduce inflammation, unclog pores, and diminish bacteria. For acne scars, more advanced treatments such as microneedling, laser resurfacing, and fractionated CO2 lasers can significantly improve skin texture and promote collagen production. Fractionated CO2 lasers are particularly effective for deeper scars, as they penetrate the skin to stimulate intense healing and skin renewal.

These procedures are usually quick, taking less than an hour, with varying downtime depending on the treatment’s intensity. A typical day for these treatments may involve a brief consultation, the procedure itself, and receiving post-care instructions from your dermatologist or plastic surgeon. You can expect some redness or mild discomfort that typically subsides within a few hours to a day, though more intensive treatments like using fractionated CO2 lasers may require a few days of recovery.

Acne Care Aftercare

Both at-home and in-office treatments of acne can lead to redness and irritation of the skin. These side effects are most common after topical therapies such as tretinoin and benzoyl peroxide, and in-office treatments like chemical peels, microneedling and the use of laser devices.

After chemical peels and laser treatments for acne, it is crucial to follow a gentle skincare regimen to aid healing and maximize results. Use a mild cleanser and hydrating moisturizer to avoid drying out the skin and apply broad-spectrum sunscreen daily to protect the skin from UV damage. Avoid using harsh or abrasive products and refrain from picking or peeling the treated skin to prevent irritation and scarring. Always ask your physician for a post-treatment skin care regimen that is tailored to your skin type and the particular procedure performed.